Klinicheskaia Meditsina[JOURNAL]
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200 papers
[SYSTEMIC INFLAMMATION AND COMPROMISED INTESTINAL BARRIER DURING SUCCESSFUL TREATMENT OF HIV INFECTION].
Shmagel NG, Shmagel KV, Korolevskaya LB … +2 more , Saidakova EV, Chereshnev VA
Klin Med (Mosk) · 2016 · PMID 27172723
UNLABELLED: The relationship between immunity disorders, destruction of intestinal barrier and development of systemic inflammation during antiviral therapy in patients with HIV infection is a topical issue in terms of s...
UNLABELLED: The relationship between immunity disorders, destruction of intestinal barrier and development of systemic inflammation during antiviral therapy in patients with HIV infection is a topical issue in terms of suppression of virus replication and reduction of its role in the pathological process. STUDY OBJECT: Blood of HIV-infected patients given antiretroviral therapy (n = 21) and non-infected volunteers (n = 20). METHODS: Identification of cells among CD4⁺ and CD8⁺ T-lymphocytes expressing markers of activation (CD38, HLA-DR), depletion (PD-1), and interleukin (IL) 7 receptor (CD127); measurement of blood levels of IL-6, neopterin, soluble CD14 (sCD14), intestinal fatty acid-binding peptide (I-FABP), and bacterial lipopolysaccharide. Correlation analysis of the dependence between cell immunity and systemic inflammation was performed. RESULTS: HIV-infected patients had more activated CD4⁺ and CD8⁺ T-lymphocytes and CD4⁺ T-cells expressing PD-1 marker than non-infected subjects but less CD4⁺ and CD8+ T-lymphocytes expressing CD127. Blood IL-6, neopterin, soluble CD14, I-FABP and bacterial lipopolysaccharide levels in the former were higher than in the latter HIV-infected patients showed significant correlation of cell immunity parameters with blood neopterin and FABP levels. CONCLUSION: The process of activation, depletion, and regeneration of T-lymphocytes in. HIV infection are related to the destruction of intestinal barrier and systemic macrophage activation.
[STRATEGY FOR THE ASSESSMENT OF COMPLIANCE WITH ANTIRETROVIRAL THERAPY IN PATIENTS WITH HIV INFECTION].
Yushchuk ND, Fedyaeva ON, Sirota NA
Klin Med (Mosk) · 2016 · PMID 27172722
The study was aimed at identifying prognostic factors of antiretroviral therapy (ARVT) in patients with HIV infection at different stages of the disease and developing an algorithm for the three-component assessment of c...
The study was aimed at identifying prognostic factors of antiretroviral therapy (ARVT) in patients with HIV infection at different stages of the disease and developing an algorithm for the three-component assessment of compliance with therapy. A total of 280 patients given ARVT for at least 6 months were available for comprehensive examination, questionnaire study for the detection of non-compliance risk factors, and psychological testing with the evaluation of non-compliance from the anxiety level (Sheehan scale) with the use of cluster analysis. The study revealed the most significant criteria for the assessment of compliance with therapy and non-compliance risk factors associated with ARVT conditions.
[CHANGES OF CAROTID AND VERTEBRAL ARTERIES IN PATENTS WITH ARTERIAL HYPERTENSION AND HEPATOBILIARY PATHOLOGY].
Polyakov VY, Nikolaev YA, Pegova SV … +2 more , Matsievskaya TR, Obukhov IV
Klin Med (Mosk) · 2016 · PMID 27172721
The study included 1172 patients (410 men and 762 women) at the mean age of 60.3 ± 10.4 years with grade I-II (stage I-II) arterial hypertension (AH) admitted to the clinic of Institute of Experimental Medicine. The pati...
The study included 1172 patients (410 men and 762 women) at the mean age of 60.3 ± 10.4 years with grade I-II (stage I-II) arterial hypertension (AH) admitted to the clinic of Institute of Experimental Medicine. The patients were divided into 2 groups based on the results of clinical and laboratory diagnostics. Group 1 (n = 525) included patients with AH and hepatobiliary system (HBS) diseases, group 2 (n = 647) patients with AH without HBS diseases. The patients group 1 had a thicker intima-media complex of carotid arteries, higher peak systolic bloodflow rate in the internal and vertebral carotid arteries, more pronounced coiling of internal carotid arteries than patients of group 2. Patients with AH and HBS diseases exhibited correlation between bloodflow rate in external carotid arteries and atherogenicity coefficient. Duplex scanning of neck vessels of in patients with AH without HBS diseases revealed peculiar changes of the intima-media thickness and hemodynamically significant changes of the blood flow in the internal carotid arteries that may be of prognostic value in this nosological syntropy and require the personified approach to diagnostics, treatment, and prevention of these conditions.
[THE PROGRAM OF PHYSICAL REHABILITATION FOR PATIENTS WITH CORONARY HEART DISEASE AND HYPERTENSIVE DISEASE].
Makarova IN, Starikov SM, Bolotov DD
Klin Med (Mosk) · 2016 · PMID 27172720
The authors demonstrate the importance of individual criteria for the choice of dosed physical load for the patients with cardiological problems during hospitalization. The analysis of the functional state and hemodynami...
The authors demonstrate the importance of individual criteria for the choice of dosed physical load for the patients with cardiological problems during hospitalization. The analysis of the functional state and hemodynamic parameters included 68 patients with various cardiovascular diseases before and after performance of the special program of physical rehabilitation. The results suggest high efficiency of the proposed treatment and good prospects for further studies in this field.
[PREDICTORS OF MODERATE COGNITIVE DISORDERS IN PATIENTS WITH CORONARY HEART DISEASE AND TYPE 2 DIABETES MELLITUS].
Trubnikova OA, Tarasova IV, Mamontova AS … +3 more , Kagan ES, Maleva OV, Barbarash OL
Klin Med (Mosk) · 2016 · PMID 27172719
AIM: To study predictors of moderate cognitive disorders (MCD) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: The study included 54 men with CPD andDM2 (mean age...
AIM: To study predictors of moderate cognitive disorders (MCD) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: The study included 54 men with CPD andDM2 (mean age 56.8 ± 4.5 years). Standard medical examination was supplemented by the assessment of cognitive status, characteristics of lipid and carbohydrate metabolism. Factors allegedly influencing MCD development included the patients' age, education level, stenosis of carotid arteries, LV ejection fraction, arterial hypertension, insulin and HbAlc levels, HOMA and QUICKI indices, lipid metabolism, concentrations of total, HDL and LDL cholesterol, fructosamine, triglycerides, severity of coronary lesions (Syntax scale), trait and state anxiety. RESULTS: Fructosamine level and HOMA index were the most important characteristics responsible for MCD in patients with CPD and DM2. CONCLUSION: The data obtained demonstrate the significance of fructosamine level and HOMA index in the development of MCD in patients with CPD and DM2.
[THE INFLUENCE OF MELATONIN ON THE PARAMETERS OF CEREBRAL HEMODYNAMICS IN PATIENTS WITH HYPERTENSIVE DISEASE].
Khoreva ET, Dem'yanenko AV, Voronin TS
Klin Med (Mosk) · 2016 · PMID 27172718
The authors discuss the results of application of melatonin in patients with hypertensive disease. Treatment with melatonin facilitated normalization of arterial pressure and cerebral hemodynamics at night time.
The authors discuss the results of application of melatonin in patients with hypertensive disease. Treatment with melatonin facilitated normalization of arterial pressure and cerebral hemodynamics at night time.
[INFLAMMATION AND CARDIAC INSUFFICIENCY ASSOCIATED WITH INFECTIOUS ENDOCARDITIS].
Fedorova TA, Tazina SY, Kaktursky LV … +4 more , Kanareitseva TD, Stefanenko NI, Burtsev VI, Semenenko NA
Klin Med (Mosk) · 2016 · PMID 27172717
The study included 62 patients with uncomplicated primary and secondary infectious endocarditis admitted to S.PBotkin city hospital from 2011 to 2014. The emphasis is laid on diagnostic significance of dynamic measuremen...
The study included 62 patients with uncomplicated primary and secondary infectious endocarditis admitted to S.PBotkin city hospital from 2011 to 2014. The emphasis is laid on diagnostic significance of dynamic measurements of the levels of C-reactive protein, tumour necrosis factor and highly sensitive troponin-1 for the evaluation of activity of the infectious/toxic process, severity of the disease, and detection of complications. The study revealed the relationship of the enhanced level of troponin-1 with changes of inflammation markers, morphofunctional characteristics of myocardium, and circulatory failure. Morphologicl study demonstrated inflammatory and dystrophic changes in myocardium, focal and diffuse cardiofibrosis suggesting development of non-coronarogenic myocardial lesions that play an important role in the progress of cardiac failure associated with infectious endocarditis.
[HOMOCYSTEINE AS A PROGNOSTIC MARKER OF ATRIAL REMODELING AND CLINICAL PICTURE IN PATIENTS WITH PAROXYSMAL AND PERSISTENT FORMS OF ATRIAL FIBRILLATION].
Snezhitsky VA, Yatskevich ES, Doroshenko EM … +3 more , Smirnov VY, Dolgoshey TS, Rubinsky AY
Klin Med (Mosk) · 2016 · PMID 27172716
The aim of this work was to study prognostic significance of the relationship between the homocysteine level, structural/functional atrial remodeling, and clinical picture of paroxysmal and persistent forms of atrial fib...
The aim of this work was to study prognostic significance of the relationship between the homocysteine level, structural/functional atrial remodeling, and clinical picture of paroxysmal and persistent forms of atrial fibrillation (AF). The study included 75 patients with AF concomitant with coronary heart disease and hypertensive disease without apparent structural changes in myocardium. Group 1 was comprised of 48 patients with paroxysmal AF, group 2 of 27 patients with persistent AF. 19 patients with coronary heart disease and hypertensive disease without AF served as controls. The structural and functional state of the heart was evaluated based on two-dimensional trans-thoracal echocardiography with the use of the formulas for calculating left ventricular characteristics. Blood homocysteine levels were measured The frequency of AF relapses was determined after an 1 year follow-up. The homocysteine level over 11.2 mcmol/l was related to left ventricle enlargement (over 40 mm), high frequency and relapse rate of AF. It is concluded that the relationship between homocysteine levels, left ventricle size, frequency and relapse rate of AF suggests the influence of homocysteine on atrial remodeling. A rise in the homocysteine level above 11 mcmol/l should be regarded as a prognostic factor of increased AF relapse rate.
[STATE-OF-THE-ART OF REALIZATION OF THE FERTILITY POTENTIAL IN THE WOMEN OF LATE REPRODUCTIVE AGE].
Ermolenko KS, Radzinsky VE, Rapoport SI
Klin Med (Mosk) · 2016 · PMID 27172715
Biological potential of childbearing in the women of late reproductive age is limited by natural impairment and loss offertility. Despite a considerable progress in clinical application of new diagnostic and reproductive...
Biological potential of childbearing in the women of late reproductive age is limited by natural impairment and loss offertility. Despite a considerable progress in clinical application of new diagnostic and reproductive technologies, the problem of infertility remains a most serious challenge. Women's age is one of the main factors responsible for the outcome of in vitro fertilization. The low effectiveness of in vitro fertilization programs is attributed to discoordination in the hypothalamic-pituitary system, depletion of ovarian resources, and deterioration of quality of reproductive material. Bearing in mind the role of melatonin in synchronizing circadian and seasonal biorhythms and regulating physiological and pathological processes, it is natural to suggest its role in the enhancement of efficiency of in vitro fertilization programs for women of late reproductive age.
[ANTICOAGULANTS TODAY].
Bokarev IN
Klin Med (Mosk) · 2016 · PMID 27172714
A review of modern concepts of clinical application of anti-thrombotic drugs, such as heparins, antivitamins K, oral anticoagulants, and thrombolytics is presented.
A review of modern concepts of clinical application of anti-thrombotic drugs, such as heparins, antivitamins K, oral anticoagulants, and thrombolytics is presented.
[E.O. MUKHIN - AN OUTSTANDING RUSSIAN ANATOMIST AND CLINICIAN (ON THE OCCASION OF HIS 250th BIRTHDAY ANNIVERSARY)].
Bakhmet AA, Klochkova SV, Sheptulin DA
Klin Med (Mosk) · 2016 · PMID 30302995
Efim Osipovich Mukhin is an outstanding representative of Russian medical science who made an important contribution to the development of anatomo-physiological studies, establishment of surgery and traumatology as indep...
Efim Osipovich Mukhin is an outstanding representative of Russian medical science who made an important contribution to the development of anatomo-physiological studies, establishment of surgery and traumatology as independent medical disciplines in this country, introduction of smallpox vaccination and aseptics into clinical practice as well as to the improvement of teaching medicine at universities.
[SELFLESSNESS OF BESIEGED LENINGRAD: PROBLEMS OF MOTHERHOOD AND CHILDHOOD (ON THE OCCASION OF THE 72ND ANNIVERSARY OF LIFTING THE SIEGE)].
Simonenko VB, Abashin VG, Aleksandrov AS
Klin Med (Mosk) · 2016 · PMID 30302994
A review of documents on the peculiarities of obstetric and gynecological care in besieged Leningrad is presented with special reference to the data about the number of children born during blockade and their health stat...
A review of documents on the peculiarities of obstetric and gynecological care in besieged Leningrad is presented with special reference to the data about the number of children born during blockade and their health status in the first months of life, the work of maternity hospitals, their number and personnel. The term «military time amenorrhea» coined during blockade is discussed.
[DOMESTIC CLINICISM AND ITS APPLICATION].
Klin Med (Mosk) · 2016 · PMID 30302993
Domestic clinicism is a methodology implying the maximum use of diagnostic and therapeutic potential of the physician in combination with the optimal application of laboratory and instrumental techniques for the choice o...
Domestic clinicism is a methodology implying the maximum use of diagnostic and therapeutic potential of the physician in combination with the optimal application of laboratory and instrumental techniques for the choice of personified means of pharmaceutical and non-pharmaceutical treatment and prophylaxis of various diseases. It can not be applied under routine working conditions of a district doctor who has only 10-15 min to handle each patient. The currently adopted principle of organization of primary medical care: “the more patients the better”, negatively affects the patients’ health and emotionally discourage doctors.
[THE ONSET OF INFECTIOUS ENDOCARDITIS WITH NEUROLOGICAL SYMPTOMS].
Burduli NM, Ranyuk LG, Tadeeva TA
Klin Med (Mosk) · 2016 · PMID 30302992
Despite the well known clinical and laboratory signs of infectious endocarditis, it remains one of the most difficult conditions in terms of diagnostics. A cause of its late diagnostics is polymorphism of the clinical pi...
Despite the well known clinical and laboratory signs of infectious endocarditis, it remains one of the most difficult conditions in terms of diagnostics. A cause of its late diagnostics is polymorphism of the clinical picture accompanied, especially at early stages, by clinical “masks” (cardiac, pulmonary, renal, cerebral, etc.). We report a case of atypical onset of the disease with multiple thromboembolism of cerebral arteries, minimal clinical manifestations, and rapid destruction of the mitral valve that required surgical intervention.
[A rare combination of systemic scleroderma, sarcoidosis and psoriasis at advanced age].
Pak YV, Men'shikova IV, Chernyak VI … +1 more , Yugai AS
Klin Med (Mosk) · 2016 · PMID 30299049
We report a rare combination of systemic sclerosis, sarcoidosis, psoriatic arthritis and diverticulosis with severe complications in a 41-year-old male who has been treated by a rheumatologist since 10 years of age.
We report a rare combination of systemic sclerosis, sarcoidosis, psoriatic arthritis and diverticulosis with severe complications in a 41-year-old male who has been treated by a rheumatologist since 10 years of age.
[Efficient treatment of chronic respiratory failure associated with morbid obesity].
Pal'man AD, Polatvskaya MG, Plaksina NA
Klin Med (Mosk) · 2016 · PMID 30299045
Severe obesity sometimes leads to chronic respiratory failure. This condition is termed obesity-hypoventilation or Pickwickian syndrome. This article reports clinical observation illustrating effectiveness of noninvasive...
Severe obesity sometimes leads to chronic respiratory failure. This condition is termed obesity-hypoventilation or Pickwickian syndrome. This article reports clinical observation illustrating effectiveness of noninvasive pressure support ventilation for the treatment of hypercapnic respiratory failure in a patient with morbid obesity. The treatment strategies for such patients are discussed.
[LISHUTA EXTRANODAL INVOLVEMENT OF THE HEART IN LYMPHOMAS: A CLINICAL CASE OF LARGE B-CELL LYMPHOMA AND LITERATURE REVIEW].
Gadaev IY, Ershov VI, Bochkarnikova OV … +4 more , Sokolova IY, Budanova DA, Kotova ES, Lishuta AS
Klin Med (Mosk) · 2016 · PMID 30299043
The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestatio...
The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestations of heart lesions in lymphoma and modern methods of their diagnostics and treatment.
[A case of rare inhibitory coagulopathy - acquired hemophilia A].
Ershov VI, Budanova DA, Gadaev IY … +4 more , Bochkarnikova OV, Sokolova IY, Antyufeeva ON, Nesterova SG
Klin Med (Mosk) · 2016 · PMID 30299033
Inhibitory coagulopathy is a rare variant of hemorrhagic syndrome. Acquired hemophilia A is caused by the formation of inhibitors (antibodies) to Factor VIII of the blood coagulation system leading to impaired activation...
Inhibitory coagulopathy is a rare variant of hemorrhagic syndrome. Acquired hemophilia A is caused by the formation of inhibitors (antibodies) to Factor VIII of the blood coagulation system leading to impaired activation of the key stage of blood clotting (factor X) and development of hemorrhagic syndrome of different severity. Acquired hemophilia A is a rare disease with an incidence of 1.38-1.48 per 1 million population per year. We report a case off severe idiopathic acquired hemophilia A in a 53 year-old woman manifest as skin hemorrhages, subcutaneous and intramuscular hematomas. Hemostatic therapy described in the article resulted in the elimination of hemorrhagic syndrome and complete remission. This case represents a rare disease the knowledge of which can be useful for preventing the development of debilitating complications, and sometimes saving the patient’s life.
[Exacerbation of chronic obstructive pulmonary disease: the role of the molecular genetic method for the identification of pathogenic agents].
Tsvetkova OA, Kolosova KY
Klin Med (Mosk) · 2016 · PMID 30299032
The study dealt with etiological diagnostics of bacterial exacerbations of chronic obstructive pulmonary disease (COPD). Samples of bronchial secretion were obtained from 73 patients hospitalized in connection with COPD...
The study dealt with etiological diagnostics of bacterial exacerbations of chronic obstructive pulmonary disease (COPD). Samples of bronchial secretion were obtained from 73 patients hospitalized in connection with COPD exacerbations and investigated by the culture method and PSR. The former technique revealed bacterial pathogens in 64 (82%) patients. Gram-positive bacteria (Streptococcus pneumoniae) predominated in patients with stage I and II COPD, Gram-negative (Pseudomonas aeruginosa) and mixt infection in those with stage III and IV COPD. CPR proved more sensitive for isolation of DNA of Gram-negative pathogens (Haemophilus influenzae and Enterobacteriaceae).
[Emotional and personality features of patients with irritable bowel syndrome and bowel inflammatory diseases].
Mnatsakanyan MG, Dyukova GM, Pogromov AP … +1 more , Tashchyan OV
Klin Med (Mosk) · 2016 · PMID 30299020
OBJECTIVE: To conduct a comparative analysis of the emotional and personality characteristics of patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in remission with IBS-like symptoms. PATI...
OBJECTIVE: To conduct a comparative analysis of the emotional and personality characteristics of patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in remission with IBS-like symptoms. PATIENTS AND METHODS: This study carried out based at a specialized gastroenterology clinic in the period from 2010 to 2015 included 125 patients with IBS (IBS-D - 46, IBS-C - 20, IBS-M - 59) and 37 patients with IBD in remission: Crohn's disease (CD) - 11 and ulcerative colitis (UC) -26 patients. The levels of depression (Beck questionnaire), urgent and personal anxiety (Spielberger questionnaire), the degree of alexithymia (Toronto scale) as well as the severity of psychopathology and behavioral symptoms (PBS) were estimated. RESULTS: Patients with IBS were not significantly different from those with IBD in remission with IBS-like symptoms in terms of depression, actual anxiety, alexithymia and PBS. Only the index of personal anxiety was significantly higher in the group of patients with IBS compared with IBD in remission with IBS-like symptoms (p = 0.0376). Men with IBS exhibited significantly higher actual anxiety than men with IBD (p = 0.04). Maximum severity of depression, anxiety and alexithymia was documented in the locking version of IBS (IBS-C) in comparison with other variants of IBS (p <0.05). Patients with CD in remission are characterized by higher rates of depression and alexithymia compared to UC (p <0.05). Behavioural disorders are most pronounced in the diarrheal variant of IBS and CD. CONCLUSION: A higher personal anxiety was observed in patients with IBS compared to those in remission of IBD with IBS-like symptoms although other parameters were not significantly different. Patients with IBS-C were characterized by more pronounced manifestations of emotional and personality disorders. More severe emotional and behavioral disorders distinguish CD from UC.
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